Wufoo

Parent's Name * First Last
Email *
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Cell Phone * ### - ### - ####
Theme/Date Selection - Sessions are filled at 20 children, when a session is filled you will be notified that you have been placed on a waiting list. *
Number of children attending, ages 0-5
Name(s) of child(ren) attending, followed by their age *
Do any of the children have allergies or other medical concerns we need to be aware of?
Do you have a church home? *
I hereby give my consent as the parent/guardian of the above named child/children to attend/participate in the Mornings with Mommy program at Amazing Love Lutheran Church at 21301 Pfeiffer Road, Frankfort, IL 60423. My child and I hereby release, indemnify, and hold harmless the church, its employees and/or volunteers from any and all liability from any claim, injury, or loss sustained by or during my child’s participation during Mornings with Mommy. I hereby authorize Amazing Love to take and use photography and/or video of my child for crafts, keepsakes, or promotional purposes in any type of media and understand I will not be compensated for any such use. Please type your full name in the box below agreeing with this consent form. *
Do Not Fill This Out